title: Surgical management of failed pyeloplasty in children: single-center experience.
abstract: OBJECTIVE
  To evaluate the outcome of secondary surgical procedures for the management of failed pyeloplasty in children.
  
  
  METHODS
  Between 1996 and 2007, 590 cases of primary ureteropelvic junction (UPJ) obstruction underwent open dismembered pyeloplasty at our center. Of these patients, 18 (3%) with recurrent UPJ obstruction (14 males, 4 females; age range: 2-15 years) have undergone management of failed pyeloplasty. Secondary intervention was by open operative procedure in all cases. Clinical and radiological outcomes were assessed. Success was defined as both symptomatic relief and radiographic resolution of obstruction at last follow up.
  
  
  RESULTS
  Follow up ranged from 8 to 41 months (mean 28). The overall salvage rate was 89%. Secondary reoperative surgery was successful in 16 patients: dismembered pyeloplasty in 14 patients (78%) and ureterocalyceal anastomosis in 2 (11%). Nephrectomy was necessitated in 2 patients (11%). No perioperative complications were encountered. All patients showed stability of renal function on radiological follow up without evidence of obstruction and with no further symptoms.
  
  
  CONCLUSIONS
  Persistent UPJ obstruction after pyeloplasty is an uncommon complication. Secondary procedures have a very high success rate with excellent functional results. Nephrectomy is indicated in rare cases of severely deteriorated renal function.
authors.affiliation: Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt.
authors.forename: Tamer E
authors.initials: TE
authors.lastname: Helmy
authors.forename: Osama M
authors.initials: OM
authors.lastname: Sarhan
authors.forename: Ashraf T
authors.initials: AT
authors.lastname: Hafez
authors.forename: Mohamed T
authors.initials: MT
authors.lastname: Elsherbiny
authors.forename: Mohamed E
authors.initials: ME
authors.lastname: Dawaba
authors.forename: Ahmad M
authors.initials: AM
authors.lastname: Ghali
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009392:Nephrectomy; D011183:Postoperative Complications / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000601:surgery*; D013520:Urologic Surgical Procedures